Engaging Providers to Transform Blood Transfusion Practices

Thibodaux Regional Health System试图改变其输血方式。Thibodaux地区的领导层意识到输血经常被过度使用，因此优先考虑让提供者参与，以减少不必要的输血，减少对患者的潜在风险，并提高护理成本。组织利用数据和分析来更好地理解改进的机会。

DESPITE COSTS, BLOOD TRANSFUSIONS REMAIN OVERUTILIZED

输血是一种挽救生命的方法。然而，它们与死亡率的增加有关，而且是美国滥用最严重的五大手术之一，尽管血液稀缺。输血也很昂贵。平均而言，每单位血液的价格为218美元，而可变的管理费用和运输成本会使价格上涨近五倍。^1,2对于卫生系统而言，这使得减少输血成为重中之重。

位于路易斯安那州Thibodaux的Thibodaux地区医疗系统是一家全国公认的卓越患者护理医院，它专注于IHI的三重目标，并找到了增加收入、降低成本、提高员工敬业度和临床结果的方法。它试图通过提高红细胞输血的效率来实现这一使命。

LACK OF STANDARDIZATION RESULTS IN OVERUSE OF BLOOD TRANSFUSIONS

Thibodaux Regional’s access to transfusion data was limited, and the organization lacked visibility into the actionable data required to effectively manage blood transfusions. In the absence of meaningful data, blood transfusion policies, procedures, order sets, and prescribing practices varied widely across the organization.

Aware that blood transfusion was often over-used, Thibodaux Regional’s leadership prioritized engaging providers to decrease unnecessary red blood cell transfusions, reduce potential risks to patients, and reduce costs of care. Thibodaux Regional leveraged its data and analytics to better understand the problem.

IMPROVING BLOOD UTILIZATION WITH THE HELP OF ANALYTICS

Thibodaux Regional’s care transformation initiative is the organization’s internal process to create a valued enterprise by achieving patient-centered excellence. Its consistent methodology engages interdisciplinary improvement teams focused on strategies to create better outcomes. The organization convened a care transformation improvement team, charging it with improving transfusion practices. Leadership engaged physician representatives from the pathology, oncology, cardiovascular surgery, internal medicine, and gastrointestinal specialties to facilitate the rapid development and adoption of improvement efforts designed to reduce red blood cell transfusions.

Thibodaux Regional used the American Association of Blood Banks (AABB) red blood cell transfusion guidelines to develop the organization’s standard transfusion policy, procedures, and order set—outlining red blood cell transfusion criteria based upon the patient’s hemoglobin levels, limiting orders for the initial number of units transfused to one.

单单位输血订单嵌入在EMR中，包含临床决策支持，实时告知订单提供者关于输血的循证适应症。在实施输血准则之前制定并提供了一项多方面的教育计划，确保提供人员了解新的红细胞输血准则和成套订货。该教育计划展示了临床证据，强调了支持限制输血的随机临床试验，并利用AABB提供的营销活动语言概述了指南。

Thibodaux Regional leverages the Health Catalyst^®Data Operating System (DOS™) platform and a robust suite of analytics applications as the foundation for its data and analytics. The organization implemented the Blood Utilization Analytics Accelerator to gain insight into the factors driving blood product utilization and management, using the analytics accelerator to guide the identification of improvement opportunities, and to standardize transfusion practices for the best clinical and financial results (see Figure 1).

The analytics accelerator provides Thibodaux Regional with near real-time visibility into details of blood product utilization, including ordering provider, specialty type, transfusion type, and patient hemoglobin level at the time of transfusion order. The organization uses the analytics accelerator to surface variation in prescribing practices, evaluate adherence to clinical indications for ordering blood, and to review the appropriateness of blood utilization on a per-patient and population basis.

Thibodaux区域可以使用实时成本数据准确地量化减少红血输血的经济影响，从而能够准确评估输血成本以及改善的机会。来自分析加速器的数据用于更新领导力的表现。提供者收到关于个人是否遵守输血指南建议的持续反馈，确保持续改进，并不会错过新的机会。

RESULTS

Thibodaux Regional transformed blood transfusion practices, ensuring the appropriate use of red blood cells, substantially reducing blood utilization and costs.

• $104K reduction in costs, the result of a 28.6 percent relative reduction in red blood cell transfusion.

We’ve been able to significantly reduce our transfusion rate and avoid unnecessary transfusions, which has improved patient safety and reduced costs.

– Greg Stock, Chief Executive Officer, Thibodaux Regional Health System

WHAT’S NEXT

Thibodaux Regional plans to continue its data-driven approach for ongoing monitoring of blood transfusions, ensuring improvements are sustained. The organization intends to focus future improvement efforts on reducing platelet utilization.

参考文献

1. Sadana, D., Pratzer, A., Scher, L. J., Saag, H. S., Adler, N., Volpicelli, F. M., Auron, M., & Frank, S. M. (2018).Promoting high-value practice by reducing unnecessary transfusions with a patient blood management program.JAMA Intern Med.
2. Kacik, A. (2017).Hospitals see improved outcomes, lower costs as blood transfusions drop.现代医疗保健。